Several studies have reported that lymph node gross tumor volume (GTVln), gross tumor volume of the nasopharynx (GTVnx), circulating CD4 T lymphocytes, lactate dehydrogenase, lactate dehydrogenase (LDH) level before treatment, hemoglobin level, and EBV DNA level were significantly associated with the distant metastases of NPC (6, 39, 40). Here, CD4 is linked to nasopharyngeal carcinoma.